ABSTRACT
Thoracic spine manipulation (TSM) is an intervention practiced by different professions, and recently an incursion of research using TSM has been published. The purpose of this review was to examine the effectiveness of TSM for the management of musculoskeletal conditions and the quality of trials that included TSM techniques. A comprehensive search of online databases was performed, and first authors of studies identified were contacted. Thirteen randomized clinical trials were included in the final review. The methodological quality of all studies was assessed using the 10-point PEDro scale. Seven of the 13 studies were of high quality. Three studies looked at TSM for treatment of shoulder conditions; however, there is limited evidence to support the use of TSM for shoulder conditions. Nine studies used TSM for the management of neck conditions. The meta-analysis identified a subset of homogeneous studies evaluating neck pain. The value of the pooled estimator (1.33) was statistically significant for the treatment effect of TSM in the studies with researcher effect removed (95 % confidence interval: 1.15, 1.52). This analysis suggests there is sufficient evidence to support the use of TSM for specific subgroups of patients with neck conditions. This review also identifies the need for further studies to examine the effectiveness of TSM to treat shoulder conditions and the effectiveness of TSM on neck conditions with long-term follow-up studies.
ABSTRACT
BACKGROUND: The reported accuracy of clinical tests for superior labral anterior posterior lesions is extremely variable. Pooling results from multiple studies of higher quality is necessary to establish the best clinical tests to use. HYPOTHESIS: Certain clinical tests are superior to others for diagnosing the presence or absence of a superior labral anterior posterior lesion. STUDY DESIGN: Meta-analysis. METHODS: A literature search of MEDLINE (1966-2007), CINAHL (1982-2007), and BIOSIS (1995-2007) was performed for (labrum OR labral OR SLAP OR Bankart) AND (shoulder OR shoulder joint OR glenoid) AND (specificity OR sensitivity AND specificity). Identified articles were reviewed for inclusion criteria. Sensitivity and specificity values were recorded from each study and used for meta-analysis. RESULTS: Six of 198 identified studies satisfied the eligibility criteria. Active compression, anterior slide, crank, and Speed tests were analyzed using receiver operating characteristic curves. The accuracy of the anterior slide test was significantly inferior to that of the active compression, crank, and Speed tests. There was no significant difference in test accuracy found among active compression, crank, and Speed tests. Between studies, methodological scores did not significantly affect sensitivity and specificity values. CONCLUSION: The anterior slide test is a poor test for detecting the presence of a labral lesion in the shoulder. Active compression, crank, and Speed tests are more optimal choices. Clinicians should choose the active compression test first, crank second, and Speed test third when a labral lesion is suspected.
Subject(s)
Arm Injuries/diagnosis , Shoulder Injuries , Humans , Physical Examination , ROC Curve , Sensitivity and Specificity , Shoulder Joint/physiopathologyABSTRACT
OBJECTIVE: To systematically review the most recent literature with meta-analysis to summarize the accuracy of clinical tests for assessing meniscal lesions of the knee. METHODS AND MEASURES: A computerized database search was performed to identify eligible articles. Identified articles were reviewed to determine eligibility and methodological quality. Sensitivity, specificity, likelihood ratios and diagnostic odd ratios were reproduced or recorded from each study. Meta-analysis was performed using the reported study sensitivity and specificity values. RESULTS: Three tests - joint line tenderness, McMurray's and Apley's - were compared in the meta-analysis. The methodological quality of the studies was found to have a significant effect on both the test sensitivities and specificities. Summary receiver operating characteristic (ROC) curves, sensitivity values, mean likelihood ratios and diagnostic odd ratios (DOR) uniformly show joint line tenderness (DOR = 10.98) to be the best ;common' test, followed by McMurray's (DOR = 3.99) and Apley's (DOR = 2.2). Thessaly's test reported the strongest DOR of 227, but samples were smaller (n = 410), than those for joint line tenderness (n = 1354), McMurray's (n = 1232) and Apley's (n = 479). CONCLUSION: Methodological quality varied from poor to fair among studies, affecting test performance. Future studies should, where possible, utilize larger samples of individuals without meniscal lesions to better estimate test specificity and thus more accurately identify optimal clinical tests.
Subject(s)
Knee Injuries/diagnosis , Physical Examination/methods , Tibial Meniscus Injuries , Evidence-Based Medicine , Humans , Magnetic Resonance Imaging , ROC Curve , Sensitivity and SpecificityABSTRACT
Lateral epicondylalgia is a commonly encountered musculoskeletal complaint. Currently, there is no agreement regarding the exact underlying pathoanatomical cause or the most effective management strategy. Various forms of joint manipulation have been recommended as treatment. The purpose of this study was to systematically review available literature regarding the effectiveness of manipulation in treating lateral epicondylalgia. A comprehensive search of Medline, CINAHL, Health Source, SPORTDiscus, and the Physiotherapy Evidence Database ending in November 2007 was conducted. Thirteen studies, both randomized and non-randomized clinical trials, met inclusion criteria. Articles were assessed for quality by one reviewer using the 10-point PEDro scale. Quality scores ranged from 1-8 with a mean score of 5.15 +/- 1.85. This score represented fair quality overall; however, trends indicated the presence of consistent methodological flaws. Specifically, no study achieved successful blinding of the patient or treating therapist, and less than 50% used a blinded outcome assessor. Additionally, studies varied significantly in terms of outcome measures, follow-up, and comparison treatments, thus making comparing results across studies difficult. Results of this review support the use of Mulligan's mobilization with movement in providing immediate, short-, and long-term benefits. In addition, positive results were demonstrated with manipulative therapy directed at the cervical spine, although data regarding long-term effects were limited. Currently, limited evidence exists to support a synthesis of any particular technique whether directed at the elbow or cervical spine. Overall, this review identified the need for further high-quality studies using larger sample sizes, valid functional outcome measures, and longer follow-up periods.